This Sexually Transmitted Diseases Cooperative Research Center will emphasize prevention of selected STDs and the consequences of STDs. In particular we are stressing STDs which have significant adverse impact on the health of women. With this approach we will identify ways in which the burden of complications associated with STDs that disproportionately result in adverse affects on the reproductive health of women can be reduced. To achieve this goal we will be taking several approaches. Two intervention studies, an indirect and direct approach, will be undertaken to prevent acquisition of bacterial vaginosis (BV), chlamydia and herpes and thereby the complications associated with these STDs. In a biologic intervention approach use of a Lactobacillus capsule will be assessed in a double blinded placebo-controlled trial to prevent infection with BV, C. trachomatis, and other genital infections. By studying the stigma associated with herpes and developing an intervention designed to produce more rational herpes-related decision making we are attempting to prevent acquisition of HSV. Determining the antimicrobial protective function of secretory leukocyte protease inhibitor (SLPI) will add to our understanding of the biologic interaction between T. vaginalis and HIV and other STDs; it also may lead to innovative vaginal microbicidal strategies. Determining the molecular mechanisms of gonococcal iron acquisition and the expression and Immunogenicity of iron acquisition will provide information relevant to developing gonococcal vaccines based on the human transferrin- binding protein complex and pathogen-targeted antimicrobial interventions targeting the iron-acquisition mechanism of N. gonorrhoeae. Studies to measure expression of the HPV genes E1, E2, E7 and E7 will expand our knowledge of HPV progression, thus allowing development of strategies to prevent cervical cancer. Determining the role of BV in spontaneous abortion will allow establishment of interventions to decrease the fetal loss associated with second trimester spontaneous abortion. This STD CRC proposal integrates clinical, epidemiological, behavioral and fundamental research into a collaborative effort by investigators from Ob/Gyn, Medicine, Infectious Diseases, Microbiology, Molecular Biology, Immunology, Behavioral Sciences and Epidemiology that addresses the disproportionate burden of the STD epidemic that affects women.